Splenic injury: a clinical study and management in a tertiary care hospital
DOI:
https://doi.org/10.18203/2349-2902.isj20151096Keywords:
Splenic injury, FAST, CT scanAbstract
Background:Splenic injury is one of the most commonly injured solid organs in blunt abdominal injury and it is often associated with significant mortality and morbidity. With the advancement in diagnosis and treatment, the management strategy has gradually changed to a non-invasive management. This study is aimed to study the Clinical presentation in a patient with splenic trauma, importance of FAST and CT scan in a patient with splenic trauma and to study the line of management in special reference to non-operative management.
Methods: A retrospective study of 30 splenic injury patients who were admitted under the Department os Surgery, GMCH between June 2012 and May 2013 was done. Data regarding demographic details, mode of injury, investigation findings, management and outcome, hospital stay and follow up were recorded and analyzed. USG (FAST) and CT scan findings were used to grade the splenic injury.
Results:30 patients were included in the study. All patients with Grade I and Grade II injury were managed conservatively. In Grade III injury 5 patients were managed non-operatively and 7 patients operatively. In Grade IV injury 4 patients were managed non-operatively while 2 patients required operative intervention. In Grade V injury, 2 patients needed splenectomy while 2 were treated conservatively. Thus, there is a trend towards non operative management of splenic injury especially in the lower Grades.
Conclusions:Non-operative management of splenic injury can be done without increased mortality and morbidity through proper monitoring, rest, blood transfusion and repeated imaging studies especially CT scan.
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References
Shackford SR, Sise MJ, Virgilio RW, Peters RM. Selective management of blunt splenic trauma. J Trauma. 1986;26:970-9.
Akio K, Toshibumi O. Emergency Center Ultrasonography in the Evaluation of Hemoperitoneum: A Prospective Study. J Trauma. 1991;31:20-3
Brasel KJ. Evaluation of the Necessity of Clinical Observation of High-Energy Trauma Patients without Significant Injury after Standardized Emergency Room stabilization. J Trauma. 1998;44:273-82.
Storck AH. Penetrating wounds of the abdomen: an analysis of forty-six personal cases. Ann Surg. 1940;111:775-819.
Elmo JC, James HS. Blunt trauma to the small intestine. J Trauma 1970;10:46-50.
Fuchs WA, Robotti G. The diagnostic impact of computed tomography in blunt abdominal trauma. Clin Radiol. 1983;34:261-5.
Sinha S, Raja SVV, Lewis MH. Recent Changes in the management of blunt splenic injury: effect on splenic trauma patients and hospital implications, Ann R Coll Surg Engl. 2008;90:109-12.
Hamilton Bailey's Emergency Surgery, 10th edition, chapter 22. 1982.
Goins WA, Rodriguez A, Joshi M, Jacobs D. Intra-abdominal abscess after blunt abdominal trauma., Ann Surg. 1990;212:60-5.
Dharap S, Changlani TT. Splenic trauma: An Indian experience. Recent advances in surgery. Jay Bro. 1996;5:235-54.
Khanna R, Khanna S, Singh P, Khanna P, Khanna AK. Spectrum of blunt abdominal trauma in Varanasi. Quarterly J Surg Sciences. 1999;35(1):25-8.
Kondreddy S. Spectrum of blunt abdominal trauma - Management and Complications. Int J Scientific Res. 2014;3:391-95.
Tripathi MD, Srivastava RD. Blunt abdominal trauma with special reference to early detection of visceral injuries. Int J Surg. 1991;53:179-84.
Carter BN, Guiseffi J. Strangulated diaphragmatic hernia. Ann Surg. 1948;128:210.
Griswold RA, Collier HS. Collective review: Blunt abdominal trauma. Surg Gynecol Obstet. 1961;112:309-29.
Davis J J, Cohn I Jr, Nance F C. Diagnosis and management of blunt abdominal trauma. Ann Surg. 1976;183:672-78
Shamim SM, Razzak JA, Umer SM, Chawla T. Splenic Injury After Blunt Abdominal Trauma. J Emergency Med. 2011;41:489-91.
Jarvis FJ, Byers WL, Platt EV. Experience in the management of the abdominal wounds of warfare. Surg Gyn Obst. 1946;82:174-93.
Cope JR, Clendinnen DG, Jacquet N. Malignant spleenic vein obstruction. Br J Radiol. 1972;45:855-7.
Rozycki GS, Ochsner MG, Feliciano DV. Early detection of hemoperitoneum by ultrasound examination of the right upper quadrant: a multicenter study. J Trauma. 1998;45:878-83.
Krivit W, Giebink GS, Leonard A. Overwhelming postplenectomy infection. Surg Clin North Am. 1979;59:223-33.
Hamidi MI, Aldaoud KM, Qtaish I. The Role of computed tomography in blunt abdominal trauma. Sultan Qaboos Univ Med J. 2007;7:41-6.
Federle MP, Griffiths B, Minagi H, Jeffrey RB. Jr Splenic trauma: evaluation with CT. Radiology. 1987;162:69-71.
Sutyak JP, D'Amelio LF, Chiu W, Amorosa J, Thomasseau J, Hammond JS. Economic impact and clinical predictors of successful non-operative treatment of adult splenic injury. J Trauma. 1994;36:158.
Stassen NA, Indermeet B, Julius CD. Selective nonoperative management of blunt splenic injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73:S294-300.
King H, Shumacker HB Jr. Splenic studies. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136:239-42.
Davis Ka, Fabian TC, Croce MA. Improved success in non-operative management of blunt splenic injuries: embolization of spelnic aretery pseudoaneurysm, J Trauma. 1998;44:1008-15.
Rajani RR, Claridge JA, Yowler CJ. Improved outcome of adult blunt splenic injury: a cohort analysis. Surgery. 2006;140:625-31.
Eraklis A J, Filler RM. Splenectomy in childhood, a review of 1,413 cases. J Pediatric Surg. 1972;7:382-8.
Singer DB. Postsplenectomy Sepsis: Perspective in Pediatric Pathology. Chicago, Year Book. 1973:285-311.
Balfanz JR, Nesbit ME Jr, Jarvis C, Krivit W. Overwhelming sepsis following splenectomy for trauma. J Pediatric. 1976;88:458-60.
Robinette CD, Fraumeni. Splenectomy and subsequent mortality in veterans of the 1939-45 war. Lancet. 1977;2:127-9.
Brasel KJ, Delisle CM, Olson CJ, Borgstrom DC. Splenic Injury. J Trauma. 1998;44:283-86.
Finelli DA, Duncan RE, Fallon WF. Current Management of Splenic Injury. AHC Media, 2008.
Allen RB, Curry GJ. Abdominal trauma: a study of 297 consecutive cases. Am J Surg. 1957;93:398-404.
Mclellan BA, Hanna SS, Monoya DA. Analysis of peritoneal parameters in blunt abdominal trauma. J Trauma. 1985;25:393-99.
Burnet FM. The natural history of surgical infection. Ann R Coll Surg Engl. 1950;7:191-203.
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